Intraocular lens post-scleral suture fixation: an ultrasound biomicroscopy study

To evaluate the intraocular lens (IOL) position after scleral suture fixation using ultrasound biomicroscopy (UBM), assess the value of the technique, and recommend ways of improving outcomes.

This observational, cross-sectional study was conducted at a university eye hospital in Fudan, China from 2023 to 2025. UBM examinations were performed on patients undergoing scleral-sutured IOL fixation for IOL dislocation, aphakia, or crystalline lens dislocation. In each eye, central crossing scans and additional scans in eight directions were obtained and analysed. Image analysis focused on IOL haptic positioning (4-grade classification system), ciliary sulcus visibility, anterior segment parameters and overall IOL positioning (IOL tilt/decentration, Image-Pro Plus software). Nonparametric statistics analysed outcome correlations (SPSS v20.0, P < 0.05 significance).

UBM examinations were performed on 65 eyes from 64 patients. High-quality images of the anterior segments were acquired in all eyes, clearly visualising the optics/haptics of the IOL, peripheral anterior synechiae, residual membrane proliferation and adhesion, and iris concavity. The analysis showed that 57.69% of the haptics were positioned within the ciliary sulcus, and in 520 images of 65 eyes, the sulcus was found in 303 images (58.27%). The haptic was asymmetrically placed in 33 eyes (50.77%). Multiple linear regression showed that haptic location discrepancy was associated with increased IOL vertical tilt (β = 1.72; 95% CI 0.65-2.79; P = 0.002), while axial length correlated with horizontal decentration (r = 0.37, P = 0.011).

UBM is a valuable tool for assessing anterior segment conditions following IOL scleral fixation. Asymmetric haptic placement significantly increases IOL tilt, while longer axial length predicts horizontal decentration. These quantifiable parameters should inform both surgical technique selection and postoperative monitoring protocols.